(a)

on the 1 April the CCG's within Devon merged and prior to the merger there were a number of objectives, one of the which both myself and Chair, Dr Paul Johnson was trying to address this issue that has been running for a long time including many conversations with colleagues in the western system;

(b)

the paper shared with the committee today went to the public governing body in October, the recommendations within the report were made by an independent group.  This has been a tricky issue and whatever was the right answer for one place was the wrong answer for somewhere else so we felt that we needed some independence and were completely committed to trying to tackle this;

(c)

a lot of discussion took place around that we should only move towards financial equity by differential investment and the governing body actually rejected that recommendation because they all felt that more flexibility was need and if we were to disinvest in one area to be able to invest in another that would leave us open.  Therefore that recommendation was amended;

(d)

the CCG currently pays a subsidy to Northern Devon locality because of its remoteness and agreed at governing body that should be set at the national value not what were currently paying and there was a significant difference between the two;

(e)

when the CCG receives its allocation there's a capitated or fair share amount for the CCG so the whole of Devon against what we actually receive and it's deemed by national policy to be acceptable for a CCG to be either 2.5% below what its fair share would be or up to 5% above and we felt given that was national policy that that would be a reasonable approach for us to take when we allocate out to each locality;

(f)

the CCG was currently ever so slightly above its fair share but very close to zero so when agreeing that we also said under recommendation 10 that where a locality has worse outcomes then the rest of the county we would look to move from below the average towards the average to an acceptable level -2.5% below and that was unacceptable we need people to move to financial equity and that would be the case for the western locality;

(g)

they set themselves a three-year pace of change but that was to get inside the 5% or -2.5% and trying to get the western locality particularly those ones that were under and have worse outcomes was that it might take slightly longer than the three years than were actually putting in.  So they put in an additional £5m into the western locality and working with colleagues in the western system around how to invest that and that there were no commitments against it so that the local team could really prioritise what were the right things to invest in and in 2021-2022 a further £5.8m which would still leave the western locality £13m below its fair share and that's the bit that we've said was still unacceptable and needs to be brought up;

(h)

they feel it's really important to go further than that but need to recognise the financial situation that we're in as a system that that may take slightly longer would like to move quicker and were working on how to invest money and have moved cash down to the system and completely intend to see that see this through.

(i)

the allocation which we haven't talked about does move around quite a lot so I'm sure previous colleagues would have been down here and said the real issue was that we were investing too much money in eastern and not enough in western and that had been the narrative.  This was true at one point.  However there were issues now in South Devon which also includes Torbay who also have poor outcomes and North Devon because of their remoteness and rurality.  They were trying to reduce and bring closer to their fair share, they were working with colleagues on an outcomes framework not just about Plymouth on how we can best make sure we tackle and understand the issues;

(j)

they also have the aspiration and want to tackle the inequity.  As mentioned £5m for 2020 – 2021 allocated to western with no commitments on how this money should be spent.  This would be decided by local leaders and not by the CCG or the governing body.  His  personal aspiration was to tackle this quickly but it was also his responsibility not to destabilise other areas as well;

(k)

to provide some assurance to the committee that you would want to see where that £5m invested and this was new money and really important that the work we're doing collectively looking at the outcomes and the impact of those outcomes on our urgent care system, community services, impact on primary care and therefore where we leave investment on a local footprint looking at role of voluntary sector and wellbeing hubs those types of things I think it's really important to say so I think just to reassure committee that you know we are absolutely looking at that preventative element in terms of addressing some of the challenges we have.